This project will evaluate a BRCA1 predisposition testing program modeled closely on the Huntington Disease paradigm for members of previously identified families in which cancer susceptibility has been linked to BRCA1 with posterior probability >90%. Although we anticipate the cloning of BRCA1 before or during the project, we will restrict participants to members of linked families because of the limitations of available risk information which has been derived from linked families only (1,2).

In order to gather important data on the psychosocial and behavioral aspects and sequelae of genetic counseling protocols for hereditary cancer, this investigation will study a consecutive series of approximately 1,000 index cases of Colorectal Cancer (CRC), identified at the UTMDACC, who will be offered molecular testing for hereditary nonpolyposis colon cancer (HNPCC) and participation in the study. From this series, approximately 65 carriers of HNPCC mutations, and 225 first degree relatives (FDRs) of those index cases will be enrolled.

This study will examine the efficacy of brief, nurse-delivered counseling intervention, Stress Inoculation Therapy (SIT), on the enhancement of psychological adjustment to the receipt of genetic cancer risk information, on the improvement of comprehension of genetic risk, and on the promotion of adherence to follow-up prevention recommendations. In addition, we will assess how coping style disposition moderates the effects of the intervention. Outcome measures will include both general psychological adjustment as well as risk-specific distress.

This project builds on an exploratory study of psychosocial and ethnocultural factors related to intentions to obtain genetic testing for heritable colon cancer, and a pilot study of genetic counseling for intermediate-risk colorectal cancer (CRC) family members.

This application proposes three interrelated phases of research. The first phase will extend the prospective descriptive study of psychosocial aspects of molecular testing for HNPCC in colorectal cancer (CRC) cases, the first degree relatives (FDRs) of CRC cases who are found to be carriers of an HNPCC mutation, and spouses/partners (S/Ps) of the FDRs. The second phase will study the psychosocial issues related to participation in a phase II randomized, controlled chemoprevention trial for HNPCC involving adherence to a Cox II inhibitor and periodic check-ups over a 1 year period.

The main goal of this proposal is to develop appropriate comprehensive counseling guidelines for predictive colon cancer gene testing by assessing perceptions and attitudes toward the gene tests, including their social and psychological determinants, and assessing the impact of the test on at-risk persons.

This project is focused on the ways in which two diagnostic technologies--screening mammography and genetic testing--emerged, diffused, interacted with medical and social thought and values, and provoked controversy. The central research questions are: What are the factors that have led to the dramatic shift in beliefs about, and practices surrounding, breast cancer risk over the past fifty years? What have been the consequences?

This project provides support for the 7th Biennial Symposium on Minorities, the Medically Underserved &Cancer. The Symposium was held February 27-March 3, 1999, at the Grand Hyatt Washington Center, Washington, DC. The overall goals of the symposium series are to:
- exchange the latest scientific and treatment information and to share strategies for reducing the disproportionate incidence of cancer morbidity and mortality among minorities and the medically underserved in the United States;